Ajovy (Fremanezumab) for Migraine Prevention
Recommended Dosing Regimen
Ajovy offers two FDA-approved subcutaneous dosing options: 225 mg monthly OR 675 mg every 3 months (quarterly), administered as three consecutive 225 mg injections. 1
Dosing Flexibility and Administration
Both dosing regimens are equally acceptable initial options with no requirement for step-therapy between doses—the choice depends on patient and provider preference for injection frequency. 1
When switching between monthly and quarterly regimens, administer the first dose of the new schedule on the next planned administration date. 1
If a dose is missed, administer as soon as possible and reschedule subsequent doses from that date. 1
Administration Instructions
Allow Ajovy to reach room temperature for 30 minutes before injection (protected from direct sunlight); do not use heat sources like hot water or microwaves. 1
Discard if left at room temperature for 7 days or longer. 1
Inject subcutaneously into the abdomen, thigh, or upper arm in areas that are not tender, bruised, red, or indurated. 1
For multiple injections (quarterly dosing), use the same body region but different exact locations. 1
Do not co-administer with other injectable drugs at the same injection site. 1
Clinical Positioning and Patient Selection
Ajovy is classified as a third-line preventive medication by the American Academy of Neurology, typically reserved for patients who have failed traditional first-line agents (beta-blockers, topiramate, amitriptyline, divalproex sodium). 2
The drug is indicated for adults with migraine requiring preventive treatment, particularly those with at least 4 migraine days per month. 1, 3
Fremanezumab demonstrated significant efficacy even in difficult-to-treat patients who had failed 2-4 classes of prior preventive medications, reducing monthly migraine days by 3.1-3.5 days compared to placebo. 4
Contraindications and Safety Considerations
Contraindicated in patients with serious hypersensitivity to fremanezumab or any excipients, including those with prior anaphylaxis or angioedema. 1
Not recommended in patients with history of stroke due to potential increased cardiovascular risk, per American Heart Association guidance. 2
Avoid in patients with impaired wound healing concerns. 2
Most common adverse events are injection site reactions (≥5% incidence), which are generally mild and transient. 1, 3
Treatment Response Evaluation
Assess treatment efficacy at 2-3 months after initiation, measuring attack frequency, severity, and migraine-related disability using headache calendars. 2
Clinical trial data shows efficacy in both episodic migraine (1.3-1.5 day reduction in monthly migraine days) and chronic migraine (4.3-4.6 day reduction) over 12 weeks. 5, 6
Responder rates (≥50% reduction in migraine days) ranged from 38-41% in chronic migraine and were significantly higher than placebo in episodic migraine. 5, 6
Special Clinical Scenarios
Fremanezumab can be used as add-on therapy with other stable preventive medications, demonstrating additional benefit (12.4 vs 7.4 day reduction compared to placebo) without significant safety concerns. 7
The American Headache Society supports selecting initial CGRP antagonist dosing based on disease severity and prior treatment failures. 2